allegheny county - pittsburgh post-gazette plan for a healthier allegheny page 8 to develop a shared...

May 2015

Allegheny County

Plan for a Healthier Allegheny

Allegheny County Health Department

Developed by: Health Resources in Action

2015 Plan for a Healthier Allegheny Page iii

542 4th Avenue, Pittsburgh, PA 15219

phone: 412.687.ACHD (2243) • fax: 412.578.8325 • www.achd.net

Dear Allegheny County Residents, We are pleased to present the 2015 Plan for a Healthier Allegheny (PHA), produced by the Allegheny County Health Department. This plan is the product of months of collaborative work with the Advisory Coalition of more than 70 stakeholder organizations representing multiple sectors affecting health in Allegheny County. Using data collected through our Community Health Assessment (CHA) we have identified five critical priority areas: Access; Chronic Disease Health Risk Behaviors; Mental Health and Substance Abuse; Environment and Maternal and Child Health. Each priority area has a series of objectives, accompanied by metrics and actionable strategies, which provide achievable health improvement for the County. The PHA is a guide for health improvement for the next 3-5 years that will require multiple partners and a strong commitment from our Advisory Coalition and County residents. We appreciate the contributions that so many have made to this work. Now we must work together to achieve our goals and make Allegheny County the healthiest County in the United States. Please join me in working towards a healthier community in which all citizens can maximize their quality of life and well-being. Sincerely,

Karen Hacker, MD, MPH Director

Lee Harrison, MD Chair, Board of Health

http://www.achd.net/

2015 Plan for a Healthier Allegheny Page v Page v

Table of Contents

Executive Summary ....................................................................................................................................................... 7

PLAN FOR A HEALTHIER ALLEGHENY .................................................................................................................................. 10

Background .................................................................................................................................................................... 10

Overview of the Plan for a Healthier Allegheny .............................................................................................. 12

a. What is a Community Health Improvement Plan? ................................................................. 12

b. How to use the PHA............................................................................................................................. 12

c. Relationship between the PHA and other guiding documents and initiatives ........... 12

Process from Planning to Action ........................................................................................................................... 13

a. Community Engagement ................................................................................................................... 13

b. Development of data-based, community identified health priorities ............................ 13

Issues and themes identified in the Community Health Assessment ....................... 13 Process to set health priorities ................................................................................................. 14

c. Development of the PHA strategic components ..................................................................... 15

PHA Framework ........................................................................................................................................................... 16

Priority Area 1: Access .............................................................................................................................. 17

Priority Area 2: Chronic Disease Health Risk Factors................................................................... 21

Priority Area 3: Environment ................................................................................................................. 26

Priority Area 4: Maternal and Child Health ....................................................................................... 30

Priority Area 5: Mental Health and Substance Abuse .................................................................. 34

Next Steps –Implementation Phase ..................................................................................................................... 34

Sustainability Plan ....................................................................................................................................................... 38

Acknowledgements ..................................................................................................................................................... 39

APPENDICES ................................................................................................................................................................................ 40

Appendix A: Participants ......................................................................................................................................... 40

Appendix B: Glossary of Terms ............................................................................................................................. 44

Appendix C: Acronyms ............................................................................................................................................. 45

Appendix D: Partners ................................................................................................................................................ 47

Appendix E: Resources ............................................................................................................................................. 47

2015 Plan for a Healthier Allegheny

Executive Summary

Where and how we live, learn, work, and play affects our health. Understanding how these factors influence health is critical for developing the best strategies to address them. To accomplish these goals, the Allegheny County Health Department led a comprehensive community health planning effort to measurably improve the health of Allegheny County residents.

This effort includes two major phases:

1. A community health assessment (CHA) to identify the health related needs and strengths of

Allegheny County

2. A community health improvement plan, our Plan for a Healthier Allegheny (PHA), to determine major health priorities, overarching goals, and specific objectives and strategies that can be implemented in a coordinated way across Allegheny County

In addition to guiding future services, programs, and policies for public health-serving agencies and the area overall, the CHA and PHA are also required for the Health Department to earn accreditation by the Public Health Accreditation Board (PHAB), a distinction which indicates that the agency is meeting national standards for public health system performance.

The May 2015 ACHD Plan for a Healthier Allegheny was developed over the period June 2014-May 2015, using the key findings from the CHA, which included qualitative data from community surveys and dialogues; as well as quantitative data from local, state and national indicators to inform discussions and determine health priority areas (Figure 1: PHA Process). The CHA is accessible at www.achd.net.

Figure 1: PHA Process

http://www.achd.net/


To develop a shared vision, for improved community health, and to help sustain implementation efforts, the Allegheny County assessment and planning process engaged community members and local public health partners through many avenues:

a. The Advisory Coalition, representing broad and diverse sectors of the community and organized around each health priority area, was responsible for selecting the health priorities, and developing the goals, objectives and strategies for the PHA.

b. The Planning Committee of the Advisory Coalition comprised of key advisory coalition members and health department leadership, was responsible for planning and orchestrating the community meetings and the processes related to development of the community health improvement plan.

c. The Data Committee of the Advisory Coalition comprised of Advisory Coalition members who assisted in developing the data for the CHA and the synthesis of data sources for issue prioritization.

d. The Allegheny County Health Department (ACHD) Leadership Team (Deputies) and staff were responsible for reviewing documents and providing subject matter expertise and data baselines and targets for defined priorities.

e. The Strategic Planning Committee of the Board of Health who participated in the PHA prioritization processes, reviewed documents, and provided input to the Board of Health.

f. The Board of Health who supported the entire CHA-PHA process. The Vision, Values and Principles for the PHA are as follows; Vision: Collective action in the areas of Access to Health Care, Chronic Disease Health Risk Behaviors, Environment, Maternal and Child Health, and Mental Health and Substance Abuse to transform the overall health as a means to improve quality of life for all residents in Allegheny County Values and Principles:

• Diverse and inclusive

• Community-centered: translating this work into communities, re-establishing trust and credibility with communities, operating with transparency and integrity

• Data-driven and evidence-based: identifying data needs and sharing and collecting existing data to be more useful

• Health equity focused

• Collaboration and integration of our efforts at all levels to maximize impact

• Demonstrable results: evaluating impact of our strategies and approaches

• Accountability and responsibility: transparency, disseminating findings and results broadly to stakeholders


The Advisory Coalition used common criteria and a multi-voting process to identify the following priority health issues and goals that would be addressed in the PHA:

1) Access: Identify and address gaps in and barriers to accessible and affordable, person-centered, high quality health care

Access to Healthcare Services Insurance Transportation

2) Chronic Disease Health Risk Behaviors: Decrease preventable chronic disease by

assuring access to resources, knowledge, and opportunities for residents to adopt healthy behaviors

Obesity/Poor Nutrition Physical Inactivity Smoking/Tobacco

3) Environment: To enhance quality of life by reducing pollution and other environmental

hazards using coordinated, data-driven interventions Air Quality Unconventional Oil and Gas Production (UOGP) Water Quality

4) Maternal and Child Health: Reduce morbidity and mortality, by improving the health and

quality of life of women, infants, children, caretakers, and their families, especially in vulnerable communities

Asthma Breastfeeding Infant Mortality Low Birth Weight Parental Support

5) Mental Health & Substance Abuse: Reduce mortality and morbidity related to mental and

substance use disorders Depression Drug and Alcohol Use Integration of Mental Health into Physical Health

Initially health equity/disparities and social determinants of health were identified as priority areas for the PHA, but Advisory Coalition members agreed that they were important cross-cutting strategic themes that should be addressed across all five priority areas of the plan. These issues have been identified as key focal points for integration and are incorporated into each priority area as a cluster of related strategies.

The release of the PHA represents an important starting point for a joint effort to improve Allegheny County health indicators. While there will always be other issues and emerging public health concerns, our community partners have chosen to work together on the five areas identified in the PHA. We are all committed to participating in the strategies outlined and overseeing progress. Our collaborative efforts will lead to greater and sustainable changes in the health of the public. Our hope is that as residents of Allegheny County, you too will see the PHA as a template for health improvement.


Plan for a Healthier Allegheny

Background

Where and how we live, learn, work, and play affects our health. Understanding how these factors influence health is critical for developing the best strategies to address them. To accomplish these goals, the Allegheny County Health Department led a comprehensive community health planning effort to measurably improve the health of Allegheny County residents.

The community health improvement planning process includes two major components:

1. A community health assessment (CHA) to identify the health related needs and strengths of Allegheny County

2. A community health improvement plan, our Plan for a Healthier Allegheny (PHA), to determine major health priorities, overarching goals, and specific objectives and strategies that can be implemented in a coordinated way across Allegheny County

The 2015 Allegheny County PHA was developed over the period June 2014-May 2015, using the key findings from the CHA, which included qualitative data from our health indicator survey and from 14 community forums, as well as quantitative data from local, state and national data sources to inform discussions and determine health priority areas. The CHA, released in April 2015, is available on the ACHD website.

Moving from Assessment to Planning

Similar to the process for the CHA, the PHA utilized a participatory, collaborative approach guided by the Mobilization for Action through Planning and Partnerships (MAPP) process.1 MAPP, a comprehensive, community-driven planning process for improving health, is a strategic framework that local public health departments across the country have employed to help direct their strategic planning efforts. MAPP comprises distinct assessments that are the foundation of the planning process, and includes the identification of strategic issues and goal/strategy formulation as prerequisites for action. Since health needs are constantly changing as communities evolve, the cyclical nature of the MAPP planning/ implementation/ evaluation/ correction process allows for the periodic identification of new priorities and the realignment of activities and resources to address them. To develop a shared vision, plan for improved community health, and help sustain implementation efforts, the Allegheny County assessment and planning process engaged community members and local public health partners through many avenues:

1 Advanced by the National Association of County and City Health Officials (NACCHO), MAPP’s vision is for

communities to achieve improved health and quality of life by mobilizing partnerships and taking strategic action. Facilitated by public health leaders, this framework helps communities apply strategic thinking to prioritize public health issues and identify resources to address them. More information on MAPP can be found at: http://www.naccho.org/topics/infrastructure/mapp/

http://www.achd.net/cha/CHA_Report-Final_42815.pdf

http://www.naccho.org/topics/infrastructure/mapp/framework/index.cfm


The Advisory Coalition, representing broad and diverse sectors of the community and organized around each health priority area, was responsible for selecting the health priorities, and developing the goals, objectives and strategies for the PHA. The CHA-PHA Planning Committee comprised of key advisory coalition members and Health Department leadership, was responsible for planning and orchestrating the community meetings and the processes related to development of the community health improvement plan. The CHA-PHA Data Committee comprised of Advisory Coalition members who assisted in developing the data for the CHA and the synthesis of data sources for issue prioritization. The Allegheny County Health Department (ACHD) Leadership Team (Deputies) and staff were responsible for reviewing documents and providing subject matter expertise and data baselines and targets for defined priorities. The Strategic Planning Committee of the Board of Health who participated in the PHA prioritization processes, reviewed documents, and provided input to the Board of Health. The Board of Health who supported the entire CHA-PHA process

ACHD’s CHA is the product of a collaborative process that mobilized our community to collect and analyze data to inform the identification of priorities for future health improvement efforts. The objectives of ACHD’s community health assessment are to: (1) characterize the overall health of Allegheny County residents; (2) evaluate the factors that influence health outcomes; and (3) identify areas in need of improvement. By working collaboratively, the Advisory Coalition and ACHD sought to develop a common agenda for population health improvement in Allegheny County. Coalition members were asked to work in partnership with ACHD to help transform the overall health and quality of life for all Allegheny County residents. This process included participation in planning, data collection, dissemination, implementation, and evaluation phases of the community health assessment and community health improvement plan. The first meeting of the Advisory Coalition was held on June 20, 2014 and attended by 60 organizations. Subsequently, all of these organizations, in addition to those that joined after the meeting, signed letters of commitment to participate as members of the Advisory Coalition. Four qualitative and quantitative sources of data were used to complete the community health assessment. These included (1) an online health indicator survey to identify top health concerns (>1,000 residents responded); (2) a synthesis of 15 Allegheny County non-profit hospital health assessments; (3) existing data compiled on top health concerns identified in the health survey and stratified by race, gender, and geography and (4) health concerns identified by over 400 county residents during 14 community meetings. A summary of the findings was presented to the Advisory Coalition in early 2015 for review. Following a full synthesis of the data, three half-day meetings were held with the Advisory Coalition in January, February and March 2015. The Advisory Coalition identified PHA priorities using a multi-voting process with dots and agreed upon selection criteria. This summary served as the official launching point for the PHA.


Overview of the Plan for a Healthier Allegheny (PHA)

A. What is a Community Health Improvement Plan? A Community Health Improvement Plan is an action-oriented strategic plan that outlines the priority health issues for a defined community, and how these issues will be addressed, including strategies and measures, to ultimately improve the health of the community. These plans are created through a community-wide, collaborative planning process that engages partners and organizations to develop, support, and implement the plan. Our PHA is intended to serve as a vision for the health of the community and a framework for organizations to use in leveraging resources, engaging partners, and identifying their own priorities and strategies for community health improvement.2 Building upon the key findings and themes identified in the Community Health Assessment (CHA), the PHA:

Identifies priority issues for action to improve community health Outlines an implementation and improvement plan with performance measures

for evaluation Guides future community decision-making related to community health

improvement In addition to guiding future services, programs, and policies for participating agencies and the area overall, the community health improvement plan fulfills the required prerequisites for Allegheny County Health Department to be eligible for accreditation, which indicates that the agency is meeting national standards for public health system performance.

B. How to Use the PHA A PHA is designed to be a broad, strategic framework for community health, and should be modified and adjusted as conditions, resources, and external environmental factors change. It is developed and written in a way that engages multiple perspectives so that all community groups and sectors – private and nonprofit organizations, government agencies, academic institutions, community- and faith-based organizations, and citizens – can unite to improve the health and quality of life for all people who live, work, learn, and play in Allegheny County. We encourage you to review the priorities and goals, reflect on the suggested strategies, and consider how you can participate in this effort, in whole or in part.

Relationship Between the PHA and Other Guiding Documents and Initiatives The PHA was designed to complement and build upon other guiding documents, plans, initiatives, and coalitions already in place to improve the public health of Allegheny County. Rather than conflicting with or duplicating the recommendations and actions of existing frameworks and coalitions, participants in the PHA planning process identified

2 As defined by the Health Resources in Action, Strategic Planning Department, 2012


potential partners and resources, including current best practices and initiatives, wherever possible.

Process from Planning to Action

A. Community Engagement The ACHD led the planning process for Allegheny County and oversaw all aspects of the PHA development, including the establishment of PHA planning session workgroups and the refinement of details for identified health priorities. PHA session participants included over 70 individuals with expertise and interest in priority areas identified in the CHA and who represented broad and diverse sectors of the community. In addition, the Strategic Planning Committee of the Allegheny County Board of Health participated in the sessions.

B. Development of Data-Based, Community Identified Health Priorities

Issues and Themes Identified in the Community Health Assessment In February 2015, a summary of the CHA findings was presented to the PHA Advisory Coalition for further discussion. The following 20 themes emerged most frequently from review of the available data and were considered in the selection of the PHA health priorities:

Access to Healthcare ACHD Perception Chronic Disease Health

Risk Behaviors Chronic Diseases -

Screening/Treatment Disparities/Cultural

Competency/Special Populations

Emergency Capability Environment Health Promotion &

Literacy

Healthcare Utilization Healthy Aging Infectious Disease Infrastructure Injury Maternal & Child Health Mental Health & Substance Abuse Nutrition Occupational Health Social Determinants of Health Sustainability Transportation


Process to Set Health Priorities Facilitators used a multi-voting process to identify the most important public health issues for Allegheny County from the list of the major themes identified from the CHA. Each planning participant received five dots to apply to their top five public health priorities, after reviewing, discussing, and agreeing upon the following selection criteria: RELEVANCE How Important Is It?

APPROPRIATENESS Should We Do It?

IMPACT What Will We Get Out of It?

FEASIBILITY Can We do It?

- Burden (magnitude and severity economic cost; urgency) of the problem

- Community concern - Focus on equity and

accessibility

- Ethical and moral issues

- Human rights issues - Legal aspects - Political and social

acceptability - Public attitudes and

values

- Effectiveness - Coverage - Builds on or

enhances current work

- Can move the needle and demonstrate measureable outcomes

- Proven strategies to address multiple wins

- Community capacity - Technical capacity - Economic capacity - Political capacity/will - Socio-cultural

aspects - Ethical aspects - Can identify easy

short-term wins

This process was followed by discussion to confirm the top five priorities and two second-tier priorities. Based on the results of the multi-voting exercise, the Advisory Coalition and ACHD leadership members agreed upon the following five priority areas and related subcategories for the PHA:

1. Access: Access to Healthcare Services, Insurance, Transportation

2. Chronic Disease Health Risk Behaviors: Obesity/Poor Nutrition, Physical

Inactivity, Smoking/Tobacco

3. Environment: Air Quality, Unconventional Oil and Gas Production (UOGP),

Water Quality

4. Maternal and Child Health: Asthma, Breastfeeding, Infant Mortality, Low Birth

Weight, Parental Support

5. Mental Health and Substance Abuse: Depression, Drug and Alcohol Use,

Integration of Mental Health into Physical Health

The Advisory Coalition and ACHD Leadership also suggested that health equity/disparities and social determinants of health be included as cross-cutting strategies for each of the PHA priorities, as appropriate. The social determinants of health are the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances in turn are shaped by a wider set of forces: economics, social policies, and politics.3 Addressing the role of social determinants of health is important

3 The World Health Organization

http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/index.html

http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/index.html


because it is a primary approach to achieving health equity. Health equity exists when everyone has the opportunity to attain their full potential and no one is disadvantaged.4

C. Development of the PHA Strategic Components The Allegheny Health Department convened two, 4-hour planning sessions held in February and March of 2015. A team of local consultants trained by and led by HRiA facilitated these sessions. ACHD staff, community members and stakeholders, as well as local content experts, participated in the planning sessions. Participants broke into five workgroups, each workgroup being responsible for drafting goals, objectives, strategies, assets, and community partners and resources for one of the identified priority areas. See Appendix A for a list of workgroup participants and affiliations. ACHD provided data summaries for each priority as well as sample evidence-based strategies from a variety of resources including Allegheny County Health Survey (2009-2010), Healthy People 2020, The Community Guide to Preventive Services, County Health Rankings, Overdose Free PA, Allegheny County Health Department (ACHD) Birth and Death Certificates, and the National Prevention Strategy for the strategy setting sessions. Following the planning sessions, subject matter experts from within ACHD as well as from external partnerships, reviewed the draft output from the workgroups and edited material for clarity, consistency, and evidence base. Each of the 5 workgroups was consulted again in the final drafting of metrics, objectives and strategies. All of this feedback has been incorporated into the final versions of the PHA contained in this report. Icons are used throughout the plan to highlight key issues, including cross-cutting strategies. An explanation for each icon may be found in the table below:

Symbol Meaning

Health Equity: Objectives, outcome indicators, strategies that address disparities and/or social determinants of health

Data: Objectives, outcome indicators, strategies that require the design, implementation, analysis and dissemination of data

Developmental: Objectives, outcome indicators, strategies for which there are no current data and for which there is an intention to gather, track, and analyze data in the future

4 Brennan Ramirez LK, B.E., Metzler M., Promoting Health Equity: A Resource to Help Communities Address Social

Determinants of Health, Centers for Disease Control and Prevention, Editor. 2008, Department of Health and Human Services, Atlanta, GA.)


PHA Framework

Goals, Objectives, Strategies, Key Partners, and Outcome Indicators Real, lasting community change stems from critical assessment of current conditions, an aspirational framing of the desired future, and a clear evaluation of whether efforts are making a difference. Outcome indicators tell the story about where a community is in relation to its vision, as articulated by its related goals, objectives, and strategies. The following pages outline the Goals, Objectives, Strategies, and Outcome Indicators for the five health priority areas outlined in the PHA. A full list of partners and resources for each priority area is located in Appendix D. A summary of data from the Community Health Assessment is included in the beginning section of each priority area. See Appendix B for a glossary of terms used in the PHA.


Priority Area 1: Access

Goal 1: Identify and address gaps in and barriers to accessible and affordable, person-centered, high quality health care.

Objective 1.1: Increase the number of Allegheny County residents receiving preventive healthcare services as recommended by United States Preventive Services Task Force (USPSTF).

Outcome Indicator

Baseline Allegheny County

Target 2020 Target Data Source

% Allegheny County residents accessing preventive care

Exploratory

Exploratory Exploratory MCOs (UPMC, Highmark, Gateway)

- 59% of women ages 40 and over had annual mammograms

- 70.8% of women who meet most recent mammogram guidelines

- 81.1% of women who meet most recent mammogram guidelines

ACHS 2009-2010

- 69% of women ages 21-29 had a pap smear in the previous year and 88% of women ages 30-70 had a pap smear within the past 3 years

- 82% of women undergoing pap smears based on most recent guidelines

- 93% of women undergoing pap smears based on most recent guidelines

- 66% of adults 50 years or older ever had a colonoscopy

- 70.5% of adults receiving most recent screening guidelines for colorectal cancer

- 70.5% of adults receiving most recent screening guidelines for colorectal cancer

- 47% of adults had a flu shot in the past year

- 56.4% of adults receive an annual flu shot

- 70% of adults receive an annual flu shot

- 35% of all adults ever had a pneumonia shot

- 42% of all adults ever had a pneumonia shot

- 90% of noninstitutionalized, adults ages 65+, 60% of noninstitutionalized high-risk adults ages 18-64, and 90% of institutionalized adults vaccinated against pneumococcal disease


Strategies 1.1.1 Establish primary preventive care metrics pertaining to utilization of

preventive care and develop data sharing relationships with MCOs and other

health providers in the area

1.1.2 Assess use of preventive care by region/age and gender (race if possible) to

understand disparities

1.1.3 Collect ACHS data on this subject to establish countywide self-reported use of

preventive care

1.1.4 Seek funding for a campaign to encourage preventive care and connection to NCQA medical homes and develop activities

Objective 1.2: Increase the percent of residents who have health insurance coverage.

Outcome Indicator Baseline Allegheny County Target 2020 Target Data Source

% of Allegheny residents with health insurance

89% of adults ages 18-64 had health care

coverage

97.9% of adults ages 18-64 had health care coverage

100% of U.S. population has

health care coverage

American Community

Survey 2009-2013

% of Allegheny residents that had to forgo treatment due to cost

11% of adults reported an instance they

needed to see a doctor but could not due to cost within the past

year

9.9% of adults reported an instance they needed to see

a doctor but could not due to cost within the past year

--- ACHS 2009-2010

Strategies

1.2.1 Assess trends in insurance cost savings measures (i.e. deductibles)

1.2.2 Implement communication strategies to inform the public about insurance options (Marketplace/PHA/Medicaid expansion)

1.2.3 Identify, catalogue, and provide education to community groups and agencies about providers and resources

1.2.4 Provide ongoing outreach to uninsured (particularly the most vulnerable) and assistance with navigation to obtain insurance through health centers, primary care, hospitals, consumer health coalition, Federal Marketplace,

private exchanges, Pennsylvania COMPASS, etc.

- 89% of kindergarten students had received the vaccines for diphtheria, polio, measles, mumps, rubella, chickenpox, tetanus and hepatitis B at time of enrollment

- 95% of kindergarten students had received the vaccines for diphtheria, polio, measles, mumps, rubella, chickenpox, tetanus, and hepatitis B at time of enrollment

- 95% of kindergarten children receiving vaccines for diphtheria, polio, measles, mumps, rubella, chickenpox, tetanus and hepatitis B

School vaccine data


Objective 1.3: Increase the number of Allegheny County residents receiving dental care.

Outcome Indicator Baseline Allegheny County

Target 2020 Target Data Source

% Allegheny County residents accessing preventive dental care

Exploratory Exploratory In development MCOs, Pitt Dental Program

Strategies

1.3.1 Develop and air ongoing PSA’s to encourage use of dental services

1.3.2 Conduct active outreach to community agencies and groups around available services and options and importance of comprehensive, preventive care

1.3.3 Examine county dental prevention programs to ensure all children have access to early preventive care

1.3.4 Develop, pilot, and evaluate tools (social media, cellphone applications, blogs, radio spots) that support utilization of preventive dental care

Objective 1.4: Improve access to health care services through improved transportation

options in Allegheny County.

Strategies 1.4.1 Assess ways to improve public visibility of ACCESS and accessibility of

information for current and potential users

1.4.2 Survey neighborhoods regarding current transportation services to identify gaps in services related to health care and work with public and private transportation service providers to fill gaps

1.4.3 Collaborate with healthcare offices to promote and accommodate hours of service and locations for patients according to transportation needs (using software to map out public transportation from home to doctor’s office to monitor access)

Outcome Indicator Baseline PHA Impact PHA Target 2020 Target Data Source

Number of OPT/ 65 Plus ACCESS trips taken by older adults to medical appointments

225,000 In development In development Port Authority

Number of MATP bus and direct reimbursement trips to medical appointments

690,000 Port Authority

Number of MATP ACCESS trips to medical appointments

165,000 Port Authority


1.4.4 Develop a collaboration between public health and transportation

a) Develop and pilot transportation-healthcare concierge service

b) Develop lending library of car seats and booster seats for ACCESS riders

c) Work with health care providers to disseminate information on MATP and OTP as options for patients


Priority Area 2: Chronic Disease Health Risk Behaviors

Goal 2: Decrease preventable chronic disease by assuring access to resources, knowledge, and opportunities for residents to adopt healthy behaviors.

Objective 2.1: Decrease obesity in school-age children.

Outcome Indicator

Baseline PHA

Impact PHA Target Healthy People

2020 Target Data Source

% of children who are

considered obese

- 14.9% of children

(grades K-6) with BMI in the 95% percentile

of weight

-10% decrease

- 13.4% of children ages (grades K-6)

with BMI in the 95% percentile

of weight

- 15.7% of children ages 6-11 who are considered obese

2011-2012 School nurses-

PA DOE - 16.1% of children

(grades 7-12) with BMI in the 95% percentile

of weight

-10% decrease

- 14.5% of children ages (grades 7-12)

with BMI in the 95% percentile

of weight

- 16.1% of children ages 12-19 who are

considered obese

Strategies

2.1.1 Work with schools and youth serving organizations to ensure that their menu options meet best nutritional practices (1% milk or skim, ½ plate fruits and vegetables, water available, eliminate sugary beverages etc.); elimination of vending machines in all schools

2.1.2 Work with schools and youth serving organizations to increase access to nutritional education for school-aged children (Adagio, Grow PGH, etc.)

2.1.3 Work with pediatric providers to increase proportion of physician visits made by all children that include counseling about nutrition or diet

2.1.4 Implement programming and policies (vending and meeting food guidelines) through non-profits and faith-based organizations to educate parents and encourage healthy eating

2.1.5 Expand the number of municipalities and school districts achieving Live Well status

*Live Well Allegheny is an innovative initiative to improve the health and wellness of county residents.

*


Objective 2.2: Increase fruit and vegetable consumption among adolescents and adults.

Outcome Indicator

Baseline PHA

Impact PHA Target

Healthy People

2020 Target Data

Source

% of adults consuming 4 or more servings of vegetables per day

In progress --- --- --- ACHS

% of adults consuming 4 or more servings of fruits per day

2% of adults ate 4 or more

servings of fruit per day, not including

juice

50% Increase

3%% of adults ate 4

or more servings of

fruit per day, not including

juice

--- ACHS

% of adolescents age 14-18 who ate an average of 4 or more servings of fruits and vegetables during the past 7 days

In progress In progress In progress --- HATS

Strategies 2.2.1 Work with grocery stores (i.e. Giant Eagle) to incentivize

consumption of fruits and vegetables- demos sampling, discounted produce, and receipt coupons

2.2.2 Implement mobile market and healthy corner store initiatives in food

deserts (Just Harvest, PFPC, GPCFB, Farm Truck Foods)

2.2.3 Target increased consumption of fruits and vegetables as part of Live Well Allegheny by providing education campaign on value of fresh fruits and vegetables, with particular emphasis on the Mon Valley through the implementation of Mon Valley Live Well Allegheny

2.2.4 Increase access to fruits and vegetables among children in Allegheny

County food deserts, through youth serving agencies

2.2.5 Target areas with food deserts and work with communities to

increase access to gardens that grow fruits and vegetables

2.2.6 Work to improve the reach of community food gardens in food deserts by working with communities and partners (i.e. Grow

Pittsburgh, YMCA branches) to develop gardening plans

2.2.7 Expand acceptance of SNAP/EBT among farmer’s curbside markets

and to targeted areas of need

2.2.8 Implement Live Well Allegheny restaurant program


Objective 2.3: Increase the number of residents by who participate in either moderate or vigorous physical activity in a usual week.

Outcome Indicator

Baseline PHA

Impact

PHA

Target

Healthy People


% of adults who are physically inactive

- 11% of adults were not

physically active

-15% decrease

- 9.4% of adults

engaging in no leisure-time

physical activity

- 32.6% of adults engaging in no

leisure-time physical activity

ACHS

% of adolescents who were physically active for a total of at least 60 minutes per day on seven of the past seven days

In progress In progress In progress

- 31.6% of adolescents grades

9-12 were physically active for a total of at least 60 minutes per day on

seven of the past seven days

HATS

Strategies 2.3.1 Expand educational opportunities and promotional campaigns on the

benefits of physical education where Allegheny County residents live, learn, work & play

2.3.2 Provide resources for design and integration of active, safe, walkable/bikable spaces into neighborhoods

2.3.3 Provide affordable and accessible opportunities for families to be physically active such as parks, trails and fitness events and facilities, particularly in underserved communities

2.3.4 Work with school boards, districts, principals and community partners to integrate physical activity into the culture of schools by offering ABC’s (Activity Breaks for Children), physical education, and/or recess

2.3.5 Launch and promote the Live Well Allegheny Workplace Program

2.3.6 Prioritize older adults, blacks, lower SES, and immigrants by focusing resources and incentivizing providers (and health plans) to invest in

areas and programs that serve these populations

2.3.7 Work with health plans to include more insurance-based subsidies

for gym membership and healthy living programs


Objective 2.4: Reduce county cigarette smoking rate among all residents and reduce racial

disparities.

Outcome Indicator

Baseline PHA

Impact PHA

Target Healthy People


% of adult smokers

23% of adults are current

smokers

5% decrease

21.8 % of adults are

current smokers

- 12% of adults are current

smokers

http://www.lung.org/ finding-cures/ our-research/trend-reports/ Tobacco-Trend-Report.pdf

ACHS

% of high School smokers

8.7% of high school

students (grades 6-12) had smoked

cigarettes within the

past 30 days

5% decrease

8.2% of adolescents (grades 9-

12) smoked

cigarettes in the past

month

16% of adolescents

(grades 9-12) smoked

cigarettes in the past month

http://www.lung.org/ stop-smoking/ about-smoking/facts-figures/ children-teens-and-tobacco.html http://www.monitoringthefuture.org/ data/14data.html#2014data-cigs

2013 PAYS

% of adult smokers stratified by race

-22% of White adults are current

smokers -35% of Black

adults are smokers - current

disparity of 13%

10% decrease

in the disparity

reduce disparity between

percent of White and

Black smokers to

11.7%

--- ACHS

Strategies 2.4.1 Increase awareness of the risks associated with tobacco use and the

PA Free Quit line and other cessation services by developing awareness campaign and marketing to high smoker areas

2.4.2 Increase number of smoke free and tobacco free parks and

playgrounds particularly in vulnerable communities

2.4.3 Decrease initiation rate of smoking through education programs in schools

2.4.4 Increase access to nicotine replacement therapy products among retailers and health plans

2.4.5 Develop a strategy and campaign to get a local tobacco tax

2.4.6 Increase the number of smoke free public housing units

2.4.7 Develop a campaign to support comprehensive clean indoor air legislation

http://www.lung.org/finding-cures/our-research/trend-reports/Tobacco-Trend-Report.pdf




http://www.lung.org/stop-smoking/about-smoking/facts-figures/children-teens-and-tobacco.html





Objective 2.5: Reduce smoking during pregnancy.

Outcome Indicator

Baseline PHA

Impact PHA Target Healthy

People 2020 Target

Data Source

% of women who abstain from cigarette smoking during pregnancy

85.1% of mothers

abstained from

cigarette smoking during

pregnancy

10% increase

93.6% of mothers

reporting smoking during

pregnancy

98.6% abstain from cigarette

smoking during pregnancy

http://www.lung.org/ stop-smoking/about-smoking/facts-figures/ women-and-tobacco-use.html

2011 ACHD birth certificates

Strategies 2.5.1 Increase awareness of cessation services for maternal health

providers

2.5.2 Increase awareness of PA Free Quitline for pregnant women.

2.5.3 Educate all teen pregnancy program providers on dangers of maternal smoking to distribute to women

2.5.4 Integrate smoking cessation counseling into home visit programs

http://www.lung.org/stop-smoking/about-smoking/facts-figures/women-and-tobacco-use.html






Priority Area 3: Environment

Goal 3: To enhance quality of life by reducing pollution and other environmental hazards using coordinated, data-driven interventions.

Objective 5.3: Assure that unconventional oil and gas production (UOGP) within Allegheny County is conducted responsibly.

Outcome Indicator Baseline PHA

Impact

PHA

Target

Healthy People


Methane emissions

from UOGP Exploratory Exploratory Exploratory --- DEP

Strategies

3.1.1 Establish ambient air monitoring for key pollutants at appropriate locations

3.1.2 Gather data and report on UOGP water usage and recycling

3.1.3 Develop an improved UOGP emissions tool

3.1.4 Improve and maintain UOGP website

3.1.5 Identify and encourage utilization of best management practices (BMPs)

Objective 3.2: Assure that public water systems, including drinking and waste water

systems, in Allegheny County meet local, state, and national primary quality

standards and operate in compliance with provisions of the Federal and

State Drinking Water Acts and their regulations.


Impact

PHA

Target

Healthy People


# of violations of local, Federal and State regulations

In progress In progress In progress ---

ACHD Public Drinking Water and Waste Management Program, PADEP eFACTS


# of binding partnerships to resolve local, federal and state violations

94 5% decrease 89 ---

ACHD Public Drinking Water and Waste Management Program, PADEP eFACTS

Strategies: 3.2.1 Maintain a high level of compliance in all public drinking water and public

waste water systems

3.2.2 Track inspections, data input into Pennsylvania Department of Environmental Protection (PADEP eFACTS) computerized tracking system

and reported quarterly

3.2.3 Develop municipal partnerships to regionalize municipal efforts for reducing the sewage overflows that result in reduced CSO advisories

3.2.4 Develop system to better coordinate and consolidate data on surveillance

of water quality

3.2.5 Develop a “one-stop shop” for water quality advisories- web based/real-time

Objective 3.3: Attain and maintain all national air quality standards within 5 years of setting the new standards for Allegheny County and effectively communicate actions to the public.


Impact PHA Target

Healthy People


Fine particulate matter range

8.7-12.0ug/m3 --- Attain

NAAQS ---

ACHD Air Quality Program 2013

# air of quality day readings greater than 100*

15 10%

decrease 13 --- ACHD Air Quality Program 2013

Ozone range 0.085-0.095ppm ---

Attain NAAQS

--- ACHD Air Quality Program 2013

Sulfur Dioxide range

0.007-0.029ppm ---

Attain NAAQS

--- ACHD Air Quality Program 2013

# of air quality days greater than 50*

190 5%

decrease 181 ---

ACHD Air Quality Program 2013

*Could change based on 2015 EPA standards

Strategies:

3.3.1 Identify sources of pollution (local and regional) and develop control/prevention strategies

3.3.2 Identify and encourage modifiable short-term actions that can be taken to prevent high air pollution days

3.3.3 Work to improve and publish local air quality forecasts

3.3.4 Convene stakeholder meetings on relevant issues


3.3.5 Publish, promote, and prioritize communication of ACHD air data

3.3.6 Identify appropriate projects for the Allegheny County Clean Air Fund

3.3.7 Track/map and make publicly available number of complaints by

municipalities and their outcomes

3.3.8 Make public participation opportunities available for the development of state implementation plans (SIPs)

3.3.9 Establish a policy that ACHD will take an enforcement action on any air pollution violation from a source that persists for more than 30 days

3.3.10 Establish policies to deter repeat air pollution violations through escalating fines for repeat offenses, and expanded inspection 3.3.11 BMP Communications from involved parties

Objective 3.4: Reduce local emissions in high priority communities in Allegheny County.

Strategies:

3.4.1 Identify environmental justice communities and develop targeted and focused strategies to address the environment’s impact on health outcomes

within these areas

3.4.2 Identify needs for additional monitoring within one year

3.4.3 Develop action plan with key stakeholders for reducing local emissions or air pollution in high priority/environmental justice communities

3.4.4 Identify appropriate projects for the Allegheny County Clean Air Fund

Outcome Indicator Baseline PHA Impact PHA Target Healthy People


Air toxics in areas of current disparity (Liberty, Avalon, and Downtown)

In progress In progress In progress --- ACHD Air Quality Program

Hospitalizations and ED visits related to cardiovascular and respiratory events in environmental justice communities


PHC4, EPICenter, UPMC ED data


Objective 3.5: Develop and support a county-wide Climate Action Plan to reduce greenhouse gas emissions.


2020 Target

Data Source

Complete greenhouse gas emissions plan

Not Completed --- Complete --- ---

Strategies: 3.5.1 Investigate existing efforts that impact the county and determine best

ways to support those efforts 3.5.2 Analyze existing emissions inventory data

3.5.3 Develop a resilience adaptation plan

3.5.4 Implement available programs included in the greenhouse gas emissions plan

3.5.5 Coordinate county-wide efforts around greenhouse gas emissions plan


Priority Area 4: Maternal and Child Health

Goal 4: Reduce morbidity and mortality, by improving the health and quality of life of women, infants, children, caretakers, and their families, especially in vulnerable communities.

Objective 4.1: Reduce asthma-related emergency room visits and hospitalizations among

all children (age 0-17), particularly targeting the Medicaid population.

Strategies 4.1.1 Partner with school nurses and physicians to ensure that each asthmatic patient

has an appropriate and complete asthma action plan

4.1.2 Educate patients on proper use of medication and on non-pharmaceutical techniques to manage asthma

4.1.3 Ensure that pediatric providers are following AAP asthma management guidelines

4.1.4 Connect diagnosed asthma patients to a medical home

4.1.5 Educate/train families to better identify environmental asthma triggers

4.1.6 Provide, and refer parents/caregivers to tobacco cessation services

4.1.7 Expand the Healthy Homes initiative to ensure proper environmental

remediation of asthma triggers in the home for asthmatic patients

4.1.8 Connect with Women for a Healthy Environment to strengthen Healthy

School efforts



Rates of asthma-related ED visits among school-age children

In progress 10% Decrease In progress 95.7 ED visits per 10,000 children less than 5 years

old

Hospital ED data

Compare rates of asthma-related visits to ED, stratified by race within Medicaid population

In progress

Decrease the disparity between

populations by 15%

In progress --- MCOs or DHS (Medicaid)

Rates of asthma -related hospital admissions for children age 0-17

In progress 10% Decrease In progress 18.2 hospitalizations per 10,000 children less than 5 years old

PHC4

Compare rates of asthma-related hospital admissions stratified by race within Medicaid population

In progress


populations by 15%

In progress --- MCOs, DHS (Medicaid)


Objective 4.2: Increase the proportion of mothers with intent to breastfeed when leaving the

hospital and reduce the disparity between White and Black populations.

Outcome Indicator Baseline PHA Impact PHA

Target

Healthy People


% of women delivering with intent to breastfeed at discharge from hospital

71% of women intended to breastfeed

5% Increase 74.6% of women

intending to breastfeed

--- 2012 Birth certificate data ACHD

% of women delivering with intent to breastfeed at discharge from hospital stratified by White/Black Populations

-71.9% White mothers

intended to breastfeed - 53.8% of

Black mothers intended to breastfeed - current

disparity is 18.1%


populations by 10%

decrease the disparity

between White and Black

populations to a difference of

16.3% ---

2012 Birth certificate data ACHD

% of women enrolled in special services who breastfed for at least 1 month


WIC, Title IV, Healthy Start

Strategies 4.2.1 Provide education and support to pregnant women and new mothers

on 1) the benefits of breastfeeding, 2) breastfeeding management, and 3) obtaining support to continue breastfeeding, especially in

those communities less likely to breastfeed

4.2.2 Advocate for better access to lactation consultants or peer counselors

4.2.3 Encourage expansion of workplace provisions to support breastfeeding employees

4.2.4 Promote and support breastfeeding-friendly practices, such as on-site breastfeeding, in child care settings, and in the workplace

4.2.5 Increase the number of Baby-Friendly Hospitals by supporting hospitals in adopting Baby-Friendly Hospital Initiative practices and achieving Baby-Friendly Hospital Initiative designation

4.2.6 Define and provide incentives to new mothers who breastfeed


Objective 4.3: Reduce the proportion of preterm, low birth weight, and very low birth weight births.

Outcome Indicator Baseline PHA Impact PHA Target

Healthy People

2020 Target

Data Source

% of preterm births 9.2% 10% Decrease 8.3% 11.4% of live

births Birth certificate data ACHD 2012

% of low birth weight births (≤ 2500g)

7.5% 10% Decrease 6.8% 7.8% of live


% of very low birth weight births (≤ 1500g)

1.1% 25% Decrease 0.8% 1.4% of live


Strategies: 4.3.1 Provide education on risks associated with pre-term births

Where/to whom: Teens/preteens, parents, home visitors, religious groups, community groups, and primary care physicians (OB, pediatrics)

What: Pamphlets that are culturally appropriate and inclusive 4.3.2 Convene home visiting agencies, medical and primary care practices,

higher education institutions, law enforcement agencies, parents, hospitals, and insurance companies, to devise strategies for reduction of preterm and low birth weight births

4.3.3 Provide home visiting programs to first-time and/or at-risk parents, for educational assessments and referrals, including increasing the use of community health workers and other paraprofessional homes

visitors 4.3.4 Provide education on pre-conception and inter-conception health 4.3.5 Establish and/or promote health care system/clinical protocols to

reduce pre-term and low birth weight births 4.3.6 Promote behavioral and community interventions, including the use of

community health workers and doulas, to 1) reduce smoking and other substance use during pregnancy, 2) prevent violence against pregnant women, and 3) address other social stressors linked to increased risk of preterm delivery

4.3.7 Advocate for, and refer to smoking cessation programs

- Advocate for insurance companies to pay for smoking cessation 4.3.8 Improve the utilization of substance abuse treatment programs

4.3.9 Utilize the following media, to increase the number of women accessing prenatal care:

Ad campaigns (in print, on buses/bus shelters, and billboards) Social media PSAs and radio ads


Objective 4.4: Reduce the overall infant mortality rate and the disparity in rates between

White and Black populations.



rate of infant deaths per 1,000 live births

5.9 deaths per 1,000 live births

5% decrease 5.6 deaths per 1,000 live

births

6.0 deaths per 1,000 live births

Death data 2012

rate of infant deaths per 1,000 live births, stratified by White and Black populations

- 3.7 deaths per 1,000 live births

among White residents

-10.3 deaths per 1,000 live births

among Black residents


populations by 10%

- decrease the disparity

between White and Black

populations to a difference of 5.9 deaths per

1,000 live births

--- Death data 2012

Strategies: 4.4.1 Educate parents on safe sleep and sudden infant death syndrome,

through home visiting, family support centers, and FQHCs

4.4.2 Utilize campaigns, home visiting, and community partnerships to provide outreach and awareness regarding pre-term births and safe sleep

4.4.3 Create a committee comprised of infant mortality experts to review prior efforts to lower infant mortality and develop and/or recommend evidence-based practices to reduce rates

4.4.5 Identify system-level factors that influence infant mortality, such as patient navigation, parental support, and enrollment in programs such as WIC and Healthy Start

4.4.6 Increase efforts to identify high-risk women through predictive modeling to inform targeting outreach efforts


Priority Area 5: Mental Health and Substance Abuse

Goal 5: Reduce mortality and morbidity related to mental and substance use disorders.

Objective 5.1: Increase utilization of outpatient behavioral health services, particularly

for the most vulnerable populations.

Strategies

5.1.1 Increase screening for mental health and substance use in primary care

5.1.2 Increase referrals to mental health by primary care providers

5.1.3 Decrease stigma by launching an anti-stigma campaign targeted to the public (Standing Together)

5.1.4 Increase knowledge of mental health and substance abuse in primary care through training

5.1.5 Increase number of students who have been referred to school based behavioral health services

5.1.6 Disseminate information to public about expanded insurance options

(Medicaid)



# of Medicaid claims for outpatient mental health services (DHS)

In progress In progress In progress --- DHS

# of students referred to school-based behavioral health services


DHS

# of “new” Medicaid mental health and substance service users



Objective 5.2: Increase knowledge and skills of first responders and community members around behavioral health.

Strategies

5.2.1 Increase the number of individuals and organizations trained in mental health first aid

5.2.2 Certify law enforcement officers in CIT (crisis intervention team) County-wide

Objective 5.3: Increase the number of adult medical providers assessing behavioral health.

Strategies

5.3.1 Assess current baseline of providers who are assessing for

behavioral health into their practices (EDs, hospitals, primary care) 5.3.2 Assess billing issues related to screening 5.3.3 Educate primary healthcare about screening for depression, anxiety,

and substance use

5.3.4 Identify screening instruments that are time efficient while maintaining a high level of sensitivity

5.3.5 Work with local hospital systems to examine the value of their data


Healthy People

2020 Target

Data Source

# of people trained in mental health first aid


DHS, Mercy Behavioral Health System, Allegheny Health Choices

# of law enforcement officers certified in CIT


DHS, Mercy Behavioral Health System



# of sites using validated screening

tools

Exploratory In progress In progress --- Exploratory


Objective 5.4: Increase the number of healthcare providers integrating children’s behavioral health and physical health.

Strategies 5.4.1 Identify payment models for screening (work with behavioral -MCO,

Department of Insurance)

5.4.2 Identify screening instruments that are time efficient while maintaining a high level of sensitivity (using instruments identified by the Screening & Assessment Workgroup and ACHD’s list of tools as a starting point)

5.4.3 Identify strategies to align electronic health record logistics (workflow, confidentiality, data sharing, etc)

5.4.4 Present appropriate instruments to major pediatric practices, independent pediatricians and other medical home providers/programs.

5.4.5 Develop and implement introduction training for behavioral health and physical health providers (“Integration 101”) including early intervention (EI) providers

Objective 5.5: Decrease the number of opiate-related drug overdose deaths.


2020 Target

Data Source

# of pediatric practices offices using validated behavioral health screens as part of children’s healthy development check-ups

In progress In progress In progress --- Launch

# of pediatric practices integrating behavioral health resources to meet the needs of young children and their families


Launch


Healthy People

2020 Target

Data Source

# of opiate- related overdose deaths

253 5% Decrease 240 --- 2014 ME Data

# of overdose- related visits to emergency departments

1,950 5% Decrease 1,852

--- ACHD

# of unique Medicaid enrollees who filled naloxone prescriptions



Strategies 5.5.1 Increase the distribution of naloxone to first responders, opiate users

and their family members and health care providers

5.5.2 Enhance/design surveillance and monitoring to effectively respond to overdoses in youth and adults

5.5.3 Increase distribution of naloxone to drug and alcohol providers in Allegheny County

5.5.4 Increase access to naloxone in pharmacies

Objective 5.6: Monitor use and increase prevention efforts for substance abuse in Allegheny County high and middle schools.

Outcome Indicator

Baseline PHA Impact PHA Target Healthy People


# of schools in Allegheny County with drug and alcohol prevention programs


DHS (performance based prevention system)

# of schools conducting either the YRBS or the PAYS

PAYS-14 YRBS-0

PAYS-25% increase

YRBS-initiate adoption of

survey

PAYS-18 YRBS-2

--- ACHD

% of high school students using opioids, tobacco, alcohol and marijuana

In progress

In progress In progress

- 16.0% of adolescents grades 9-12 reported smoking cigarettes in past 30 days -8.6% of adolescents ages 12-17 reporting binge drinking during past 30 days - 6% of adolescents ages 12-17 reporting use of marijuana during past 30 days

HATS

Strategies

5.6.1 Assess the number of schools with drug and alcohol evidenced based prevention programs

5.6.2 Expand drug and alcohol prevention efforts in schools with unmet

needs

5.6.3 Work with schools to implement youth risk behavior survey

5.6.4 Monitor drug and alcohol use in high school students

5.6.5 Identify and implement priorities from HATS survey


Next Steps – Implementation Phase The components included in this report represent the strategic framework for a data-driven, Plan for a Healthier Allegheny (PHA). The Allegheny County Health Improvement team, including the core agencies, PHA workgroups, partners, stakeholders, and community residents, will continue finalizing the PHA by finalizing metrics, prioritizing strategies, developing specific 1-year action steps, assigning lead responsible parties, and identifying resources for each priority area. Four community meetings will also be held to inform the public about the plan in Summer 2015. Workgroups will then meet quarterly to review progress and adjust plans. An annual PHA progress report will illustrate performance and guide subsequent annual implementation planning.

Sustainability Plan As part of the action planning process, partners and resources will be solidified to ensure successful PHA implementation, and to coordinate activities and resources among key partners in Allegheny County. The Advisory Coalition will continue to provide executive oversight for the improvement plan. The Advisory Coalition will meet regularly and be staffed by ACHD’s Accreditation Coordinator. Regular communication/reports will be made available via email. New and creative ways to feasibly engage all parties will be explored throughout implementation of the PHA.


Acknowledgements

The dedication, expertise, and

leadership of the following

agencies and people made the

2015 Plan for a Healthier

Allegheny a collaborative,

engaging, and substantive plan

that will guide our community in

improving the health and wellness

for the residents of Allegheny

County. Special thanks to

members of the Allegheny County

Health Department’s Advisory

Coalition:

Adagio Health

Aetna Better Health

Allegheny Conference on Community

Development

Allegheny County Economic Development

Allegheny County Library Association

Allegheny County Medical Society

Allegheny County Pharmacists Association

Allegheny County Department of Human

Services

Allegheny Health Network

Allegheny Intermediate Unit

Allies for Children

American Diabetes Association

Bike Pittsburgh

Blind & Vision Rehabilitation Services of

Pittsburgh

Carnegie Mellon University

Catholic Charities

City of Pittsburgh

Clean Water Action

Community College of Allegheny County

(CCAC)

Consumer Health Coalition

Duquesne University

Early Head Start

East Liberty Health Care Center

EvolveEA/Green Building Alliance

Forbes Funds

Gateway Health Plan

Gay & Lesbian Community Center

Giant Eagle

Grable Foundation

Greater Pittsburgh Community Food Bank

Group Against Smog and Pollution

Grow Pittsburgh

GTECH

Healthy Start, Inc

Heinz Endowments

Highmark, Inc.

Highmark Foundation

Hillman Family Foundations

Human Service Center Corps

Institute of Politics

Jefferson Regional Foundation

Jewish Family & Children's Service

Jewish Healthcare Foundation

Just Harvest

Let's Move Pittsburgh

Neighborhood Allies

Ohio Valley Hospital

Penn Future

Pittsburgh AIDS Task Force

Pittsburgh Mercy Health System

Pittsburgh Parks Conservancy

Pittsburgh Public Schools

Port Authority

Prevention Point Pittsburgh

Richard King Mellon Foundation

Squirrel Hill Health Center

Southwest PA Area Health Education Center

(AHEC)

Staunton Farm Foundation

Steel Valley COG

Sustainable Pittsburgh

The Pittsburgh Foundation

Tobacco Free Allegheny

United States Steel Corporation

United Way of Allegheny County

University of Pittsburgh Graduate

School of Public Health

University of Pittsburgh UCSUR

UPMC

UPMC Health Plan

Urban League of Pittsburgh

Western Psychiatric Institute and Clinic

YMCA

In 2014, ACHD hired Health Resources in Action (HRiA), a non-profit public health organization located in Boston, MA, as a consultant partner to provide strategic guidance and facilitation of the PHA process, and develop the resulting plan. HRiA has extensive experience developing health assessments and health improvement plans regionally, and nationally, including state-level plans in Massachusetts and Connecticut. Over the past two years, HRiA has assisted both local and State health departments in meeting the required assessment and planning standards for Public Health Accreditation Board (PHAB) accreditation.


Appendices

Appendix A: Participants

Planning Committee

Myron Arnowitt Clean Water Action

Terri Blanchette Allegheny County Library Association

Debra Caplan Allegheny Health Network

Mara Christy Allies for Children

Patrick Dowd Allies for Children

Erika Fricke Allies for Children

Grant Gittlen City of Pittsburgh

Tom Hoffman Clean Water Action

Susan Kalson Squirrel Hill Health Center

Stephanie Murtaugh Pittsburgh Mercy Health System

Gretchen North YMCA

Karen Pater ACPA

Mary Kathryn Poole Let’s Move Pittsburgh

Mark Rogalsky Pittsburgh Mercy Health System

Erin Saltmarsh Let’s Move Pittsburgh

Jesse Sharrard Greater Pittsburgh Community Food Bank

Valessa Souter-Kline Penn Future

Angel Thompson Ohio Valley Hospital

Karen Virostek Adagio Health

John Williams Allegheny County Medical Society


Data Committee

Barry Adams Port Authority

Stephen Albert Graduate School of Public Health

Mara Christy Allies for Children

Erin Dalton Department of Human Services

Patrick Dowd Allies for Children

Rachel Filippini Group Against Smog and Pollution

Bob Gradeck UCSER

Brittany Huffman Tobacco Free Allegheny

Lisa Kuzma RK Mellon Foundation

Laura Meixell City of Pittsburgh

Stephanie Murtaugh Pittsburgh Mercy Health System

Mary Phan-Gruber Jefferson Regional Foundation

Dana Rofey WPIC

Christina Wilds Highmark Foundation

Michael Yonas Pittsburgh Foundation


SUBJECT MATTER EXPERT REVIEWERS Additional input provided by: Susan Kalson, Squirrel Hill Health Center John Lovelace, UPMC Health Plan Barry Adams, Port Authority Debra Caplan, Allegheny Health Network Gretchen North, YMCA Mark Rogalsky, Pittsburgh Mercy Health System Brittany Huffman, Tobacco Free Allegheny Tamara Dubowitz, Rand Corporation Myron Arnowitt, Clean Water Action Michael Dzurinko, United States Steel Corporation Tishie Woodwell, United States Steel Corporation Pat Valentine, Allegheny County Department of Human Services Eric Hulsey, Allegheny County Department of Human Services Latika Davis-Jones, Allegheny County Department of Human Services Ty Gourley, Hillman Family Foundation Michael Yonas, The Pittsburgh Foundation ACHD Staff reviewers: Dr. Karen Hacker, Director Dr. LuAnn Brink, Bureau of Assessment, Statistics, and Epidemiology Dr. Roderick Harris, Bureau of Community Health Promotion and Disease Prevention Ron Sugar, Bureau of Administration Jim Thompson, Bureau of Environmental Health Abby Wilson, Bureau of Public Policy & Community Relations Casey Monroe, Executive Policy Advisor Michelle Kurta, Bureau of Assessment, Statistics, and Epidemiology Jennifer Fiddner, Bureau of Assessment, Statistics, and Epidemiology Stephen Forest, Bureau of Assessment, Statistics, and Epidemiology Lynne Marshall, Air Quality Program Michelle Buys, Public Drinking Water & Waste Management Program Geoff Butia, Public Drinking Water & Waste Management Program Jayme Graham, Air Quality Program Jim Kelly, Air Quality Program Kyle Craig, Child Health Programs Dannai Harriel, Maternal and Child Health Program Patti Waag, Women, Infants, and Children Program Sandra Thompson, Dental Program Hannah Hardy, Chronic Disease Program


Consultant Advisors Health Resources in Action, Inc. Kathi Boyle Melanie Grafals Danielle Katz Alyssa Landen Lindsey Miller Darrell Phillips Makeda Vanderpuije

In Kind Contributors Allegheny County Library Association Allegheny General Hospital Baldwin High School Giant Eagle Human Service Center Corps. Ohio Valley Hospital Pittsburgh Pirates Shaler Area High School YMCA


Appendix B: Glossary of Terms Low Birth Weight - Infants who weigh less than 2,500g at birth

Very Low Birth Weight – Infants who weigh less than 1,500g at birth

Formulas for Rates

Infant Mortality Rate = Number of deaths under 1 year of age X 1,000

Number of live births

Race-Specific Infant Mortality Rate = Number of infant deaths of specified race X 1,000

Number of live births of specified race of mother

Race-specific mortality rates are calculated using births by

maternal race rather than by child’s race. This change was

recommended by the National Center for Health Statistics

(NCHS) and was to be implemented by the nation and all states

beginning with 1989 data. One rationale for this change is the

increasing number of births where the parents are not of the

same race. In these cases, race of child (which itself is not of the

birth certificate), is assigned by an algorithm using the races of

the parents. This algorithm may not accurately reflect certain

minority births, particularly among non-Black minorities.

Percent Breastfeed = Number of mothers intending to breastfeed X 100

Total number of live births – those with unknown breastfeeding intentions

Percent Low Birth Weight = Number of Births under 2500 grams X 100

Total number of live births


Appendix C: Acronyms AAP- Asthma, Allergy, and Immunology Clinical Guidelines

ACHD – Allegheny County Health Department

ACHS – Allegheny County Health Survey

ACS – American Communities Survey

BH – Behavioral Health

CHA – Community Health Assessment

CDC – Centers for Disease Control and Prevention

CIT – Crisis Intervention Team

DEP – Department of Environmental Protection

DHS – Department of Human Services

EPA – Environmental Protection Agency

ED – Emergency Department

FQHC – Federally Qualified Health Clinic

HATS – Healthy Allegheny Teen Survey

HRiA – Health Resources in Action

PHC4 – Pennsylvania Health Care Cost Containment Council

MATP – Medical Assistance Transportation Program

MCOs – Managed Care Organizations

ME – Medical Examiner

NACCHO – National Association of County and City Health Officials

LAUNCH – Linking Actions for Unmet Needs in Children’s Health

PA - Pennsylvania

PADOE – Pennsylvania Department of Education

PADOH – Pennsylvania Department of Health

PAYS – Pennsylvania Youth Survey

PH – Physical Health

PHA –Plan for a Healthier Allegheny

PHAB – Public Health Accreditation Board

PSAs - Public Service Announcements

UPMC – University of Pittsburgh Medical Center

U.S. – United States

USPSTF – United States Preventive Services Task Force

YRBS – Youth Risk Behavior Survey


Appendix D: Advisory Coalition Partners Priority Area 1: Access

Priority Area 2: Chronic Disease Risk Behaviors




Priority Areas Partners and Resources

4 Adagio Health 1 Aetna Better Health 3 Allegheny Conference on Community Development 2 Allegheny County Economic Development

1 Allegheny County Library Association 1 Allegheny County Medical Society 2 Allegheny County Pharmacists Association 4 5 Allegheny County Department of Human Services

1 Allegheny Health Network 4 Allegheny Intermediate Unit 4 Allies for Children 2 American Diabetes Association 5 Bike Pittsburgh

1 Blind & Vision Rehabilitation Services of Pittsburgh 3 Carnegie Mellon University 4 Catholic Charities 2 City of Pittsburgh 3 Clean Water Action

1 Community College of Allegheny County 1 Consumer Health Coalition 4 Council of Three Rivers American Indian Center, Inc., Early Head Start

1 Dept. of Human Services/Area Agency on Aging 2 Duquesne University

1 East Liberty Family Health Care Center 3 EvolveEA/Green Building Alliance

1 Forbes Funds 1 Gateway Health Plan 1 4 Gay & Lesbian Community Center 2 Giant Eagle 4 Grable Foundation 2 Greater Pittsburgh Community Food Bank 3 Group Against Smog and Pollution 2 Grow Pittsburgh 3 Growth Through Energy & Community Health (GTECH) 2 Healthy Start, Inc 4 Heinz Endowments 4 Highmark, Inc.

1 Highmark Foundation 4 Hillman Family Foundations 2 Human Service Center Corps


1 Institute of Politics (University of Pittsburgh) 5 Jefferson Regional Foundation 2 Jewish Family & Children's Service 5 Jewish Healthcare Foundation 2 Just Harvest 2 Let's Move Pittsburgh

1 Neighborhood Allies 1 Ohio Valley Hospital 3 Penn Future 2 Pittsburgh AIDS Task Force 5 Pittsburgh Mercy Health System 3 Pittsburgh Parks Conservancy 2 4 Pittsburgh Public Schools

1 Port Authority 5 Prevention Point Pittsburgh

1 Richard King Mellon Foundation 1 Squirrel Hill Health Center 4 Southwest PA Area Health Education Center (AHEC) 5 Staunton Farm Foundation 3 Steel Valley COG 2 3 Sustainable Pittsburgh 4 The Pittsburgh Foundation 2 Tobacco Free Allegheny 3 United States Steel Corporation 2 United Way of Allegheny County

1 2 4 University of Pittsburgh Graduate School of Public Health 4 University of Pittsburgh UCSUR

1 UPMC 1 UPMC Health Plan 4 Urban League of Pittsburgh 5 Western Psychiatric Institute and Clinic 2 YMCA


Appendix E: Additional Stakeholders,

as Identified by Advisory Coalition Priority Area 1: Access

Priority Area 2: Chronic Disease Risk Behaviors




Priority Areas Partners and Resources

2 412 Food Rescue/The Kitchen Project 1 2 4 Allegheny County Housing Authority

2 Allegheny County Parks

2 Allegheny County Parks Foundation

3 Allegheny County Sanitary Authority (ALCOSAN)

4 Alliance for infants and children i.e., early intervention services

4 American Academy of Pediatrics – PA chapter

2 American Healthcare Group

3 American Lung Association

2 Boys and Girls Clubs

4 Breastfeeding Center of Pittsburgh

1 Care navigators

2 Center for Disease Control and Prevention (CDC)

5 Center for Victims of Violent Crimes

2 Charter Schools

2 Children’s Hospital of Pittsburgh

2 Chronic Disease Association

1 Churches and religious communities

2 CitiParks

2 Community Development Corporations & Community Groups

1 Community health workers

2 Community Kitchen Pittsburgh

4 Convenience stores

4 Corner stores

2 County magistrates

4 Cribs for Kids

4 DART

1 4 Dentists specifically pediatric dentists

2 Dick’s Sporting Goods

2 Duquesne University Pharmacy

5 Elected Officials

1 2 Employers

3 Environmental Advocacy Groups

3 Environmental Protection Agency (EPA)

5 Faith Based Organizations

1 Families and ACCESS System for transportation

4 5 Family support centers

2 Farm Truck Foods


1 Federal Marketplace

1 2 4 5 Federally Qualified Community Health Centers (FQHCs)

2 Fittsburgh

4 Food Access

2 Food Revolution Pittsburgh Cooking Club

3 Foundations

3 Fractracker

2 Friends of the Riverfront

5 Good grief center

2 Green Space Alliance

2 5 Healthcare delivery systems

1 Heritage Community Initiative

5 Highmark Caring Place

2 Hill House Association

4 5 Home visiting stakeholders groups (Allegheny Cares)

5 Homeless and Domestic Violence Shelters

2 Homewood Children’s Village

5 Hospital Networks

3 4 Hospitals

1 5 Immigration and Refugee Council

3 Industry

1 Insurance navigators

2 Jewish Community Center

4 Lactation consultants

5 Law Enforcement

2 Local Churches/Faith Based Community

4 Magee Women’s Research Institute

1 Medical Assistance Transportation Program (MATP)

2 5 Media

5 Mental Health America

5 Mental health providers

5 Methadone Clinics

2 Municipalities/Councils of Governments

4 NAACP

5 National Association of Mental Illness

4 Nurses (Early Childhood Centers)

4 Pathology

5 OD collaborative

3 PA DEP

4 Partners in vulnerable communities

3 PCRG

1 4 Pediatricians

5 Persad

1 4 Pharmacies

5 Pittsburgh Action Against Rape

2 Pittsburgh Food Policy Council

2 Pittsburgh Penguins

2 Pittsburgh Pirates

2 Pittsburgh Play Collaborative

2 Pittsburgh Steelers

2 Pittsburgh Three Rivers Marathon, Inc.


2 Pittsburgh Tri Club

2 Police Athletic League

1 Primary care doctors

4 Public Health/Public Administration

5 Rand Corporation

5 Re:Solve

5 Recovery community organizations

2 Regional Trail Corporation

2 RiverLife Task Force

3 ROCIS (Reducing Outdoor Contaminants in Indoor Spaces)

2 Run/Walk Races & Events

4 School nurses

2 4 School districts/systems

4 Social service providers

4 Social workers

3 Southwestern PA Air Quality Partnership

5 State DHS

4 Students

2 Teen pregnancy centers

4 Three Rivers Mothers Milk Bank

3 Three Rivers Wet Weather

4 Traffic Safety specifically Kohl’s car seat initiative

1 Translators

1 Traveler’s AID

2 Unions (teachers)

1 United Way information and services

1 3 5 Universities

2 Urban Redevelopment Authority

2 Venture Outdoors

5 Veterans Affairs

1 Volunteer organizations for transportation

2 Walk Pittsburgh

4 Women for a Healthy Environment

2 WPIAL/PIAA: High School Athletics

4 YMCA/Community centers